Postshunt cognitive and functional improvement in idiopathic normal pressure hydrocephalus.
| Publication Type | Academic Article |
| Authors | Katzen H, Ravdin L, Assuras S, Heros R, Kaplitt M, Schwartz T, Fink M, Levin B, Relkin N |
| Journal | Neurosurgery |
| Volume | 68 |
| Issue | 2 |
| Pagination | 416-9 |
| Date Published | 02/01/2011 |
| ISSN | 1524-4040 |
| Keywords | Cerebrospinal Fluid Shunts, Cognition Disorders, Gait Disorders, Neurologic, Hydrocephalus, Normal Pressure |
| Abstract | BACKGROUND: Improvement in gait after shunt placement has been well documented in idiopathic normal pressure hydrocephalus (iNPH); however, controversy remains regarding the extent and pattern of postsurgical cognitive changes. Conflicting findings may be explained by variability in both test selection and follow-up intervals across studies. Furthermore, most investigations lack a control group, making it difficult to disentangle practice effects from a true treatment effect. OBJECTIVE: To examine postshunt changes in a sample of well-characterized iNPH participants compared with a group of age- and education-matched healthy control subjects. METHODS: We identified 12 participants with iNPH undergoing shunt placement and 9 control participants. All participants were evaluated with comprehensive neuropsychological testing and standardized gait assessment at baseline and were followed up for 6 months. RESULTS: Repeated-measures analysis of variance revealed a significant group- (iNPH and control) by-time (baseline and 6 months) interaction for Trailmaking Test B: (P < .003) and Symbol Digit Modalities (P < .02), with greater improvement in iNPH participants relative to control subjects. In addition, the iNPH group showed greater improvement in gait (P < .001) and caregivers reported improved activities of daily living (P < .01) and reduced caregiver distress (P < .01). CONCLUSION: This study demonstrates improvements in mental tracking speed and sustained attention 6 months after shunt placement in iNPH. The present investigation is the first study to use a controlled design to show that cognitive improvement in iNPH is independent of practice effects. Furthermore, these findings indicate functional and quality-of-life improvements for both the shunt responder and their caregiver. |
| DOI | 10.1227/NEU.0b013e3181ff9d01 |
| PubMed ID | 21135747 |
| PubMed Central ID | PMC3624902 |